Screening of ZIKA virus infection among dengue-like illness patients with negative RT-PCR for dengue virus in Punjab - Pakistan.

Somia Iqtadar,Mamunur Rahman Malik,Mehreen Mehmood,Muhammad Salman,Thuan Huu Vo,Nhu Nguyen Tran Minh,Faisal Masud

doi:10.12669/pjms.37.3.3369

Abstract

Objective:To detect ZIKV using reverse transcription-polymerase chain reaction (RT-PCR) among clinical samples tested negative for Dengue virus (DENV) by RT-PCR in Punjab, 2016.Methods:A descriptive cross-sectional study was carried out for duration of two months. Total of 506 samples were collected within seven days from onset of illness from all over hospitals of Punjab, Pakistan of which 350 were selected simply randomly to test for presence of ZIKV by using “Trioplex Real-Time RT-PCR Assay (Trioplex)”. Cohen’s kappa coefficient (κ) and 95% confidence interval (CI) were used to assess the degree of concordance between DENV positive results of non-structural protein 1 (NS1) and IgM solid-phase enzyme immunoassay (ELISA).Results:No samples were positive for any ZIKV, DENV or Chikungunya virus (CHIKV) by Trioplex. Among the 350 samples, 26 samples were positive concordant and the degree of concordance between NS1- and IgM-ELISA was 13% and κ coefficient was -0.71 (95% CI -0.79, -0.63).Conclusion:At study time, no samples were positive for ZIKV. Strengthening laboratory capacity to confirm arboviruses for Punjab’s laboratories is warranted. Trioplex RT-PCR has 100% sensitivity so there are nominal chances of false negative results. Establishing syndromic surveillance for Zika and conducting a sero-surveillance survey for Zika in areas with high human and Aedes mosquito density are recommended in Punjab.

Highlights

Many repeated outbreaks of Aedes-borne diseases such as Dengue and Chikungunya, have been reported from Pakista,[8] especially in Punjab, where number of reported dengue cases accounted for 74% of total cases in Pakistan in the period of 2006–2011,7 Punjab is the most populated province with about 40% of population living in urban areas.[9]
The symptoms of the patients were compatible with dengue-like illness but the disease was not dengue
80% samples collected within 4–6 days after illness onset, the Zika virus (ZIKV) negative results by reverse transcription-polymerase chain reaction (RT-PCR) could not be explained as a decline in the level of viremia over time

Summary

Introduction

Zika virus (ZIKV), transmitted predominantly by Aedes mosquitos, has caused major outbreaks in Micronesia, French Polynesia, Brazil and elsewhere in tropic and sub-tropic areas in recent years.[1,2] The proportion of asymptomatic Zika infection is high (80%) and Zika infection is potentially associated with some severe complications including microcephaly, Guillain-Barré syndrome, and Congenital Zika syndrome.[3,4]Pak J Med Sci May - June 2021 Vol 37 No 3 www.pjms.org.pk 721The risk of importation of ZIKV to Pakistan from viraemic travellers is tangible.[2,5,6] The Aedes mosquitoes are in abundance in Pakistan no human cases of ZIKV infection have been reported so far.[7]. The high urban population density and abudance of competence vector may result in the high risk of local transmission following the introduction of ZIKV through travel in Punjab, Pakistan

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